Menopause and the heart

A conversation with Dr. Avrum Bluming, oncologist and the author of the updated version of Estrogen Matters, on the link between estrogen loss and heart palpitations.

Heart disease is the leading cause of death for women in the U.S. But we’re only just figuring out now how much of a role the loss of estrogen in menopause might play.

If it seems as if I’ve been a bit quiet of late, it’s because I just finished a 3000-word personal essay on osteoporosis for The Guardian and another 3000-word story on Kate Winslet’s new film Lee for Francesca Donner’s publication, The Persistent, both of which are in the hands of my editors right now. I will share each of them when they are published.

Francesca was the gender director at the New York Times and the editor of “In Her Words,” a section of the NYT you may remember because it always had stuff you wanted to read. But in 2021, less than a year before Roe v. Wade was overturned, the New York Times decided we live in a post-gender world and shut it down.

Anyhoo! Go see Lee this weekend, if only to let Hollywood know that, yes, you do want to see films about female protagonists who are flawed, have agency, kick ass, push back, get mad, and are not afraid to appear on screen without makeup or botulism injections.

Here’s some more post-gender bullshit: yesterday, the Guardian published this excellent article, “Women dying ‘unnecessarily’ of heart disease, say experts,” highlighting an important new article, by Dr. Vijay Kunadian and others, in the medical journal Heart. For me, here was the key pull quote from the latter:

“The menopause is the most striking example of how hormonal fluctuation impacts on cardiovascular health. Several mechanisms linking oestrogen deficiency and CAD have been proposed, including alteration in fat distribution and heightened BP. Postmenopausal women are also more susceptible to coronary vasomotor disorders due to a higher prevalence of systemic inflammation.”

As an interesting addition to that study, I’d like to share a side conversation I had with Dr. Avrum Bluming, oncologist and co-author of the recently updated and revised Estrogen Matters, back in late August, before that article in Heart was published. I was interviewing Avrum predominantly about osteoporosis for the Guardian story, but then I asked him to stay on the Zoom for a few minutes more to talk to me about heart disease and estrogen as well.

Why? Here’s what happened: last month, I drove down to Bethany Beach, Delaware to visit my mom, my aunt, my three sisters, and our various family members. A big family reunion, in other words, during which, oops, I forgot to bring my Oestrogel. It’s spelled with an O because I get it at IsraelPharm.com for $17 a tube instead of the outrageous $200-$300 a month I was paying for Divigel, which my insurance company suddenly decided not to cover, followed by patches that were cheaper and were covered by my insurance but made my skin itch.

In other words, it wasn’t as if I could just order a new tube and have it shipped from Israel to my mom’s house in time for it to make any difference. I figured a week off systemic estrogen couldn’t hurt, no biggie. I’d start taking it again when I returned to Brooklyn.

Well? I was wrong. After a few days of not being on estrogen, not only did my hot flashes return, but my PVCs—premature ventricular contractions—came back with such a vengeance they sometimes knocked me off my feet. On vacation. When I wasn’t stressed out at all, even though my cardiologist, back in 2016, blamed my PVCs on stress, as readers of my book Ladyparts might remember. Here’s a photo of our vacation gang while I was having a major hot flash, after not having had a single one since starting estrogen.

Here I am, upper right, sweating through a hot flash because I forgot to bring my Oestrogel on vacation.

“I think it's important to recognize that one of the strongest motivators for people to invest in hormone replacement therapy, both physicians and lay consumers, is that hormone replacement therapy decreases the risk of serious heart disease by 50%. That's incredible. Why is it incredible? Because seven times as many women die of heart disease as die of breast cancer. And most women don't talk about heart disease, but they do talk about breast cancer.”

-Dr. Avrum Bluming, author of Estrogen Matters

So I asked Dr. Bluming: Could those PVCs back in 2016 have been cured by estrogen instead of the myriad of strong drugs I was given, all of which I had to abandon due to serious side effects? Here was his response, the video of which I will post below for all readers gratis, because this information is so important to get out there. Paid subscribers will have access to the full transcript of our conversation below the video.

Deborah Copaken: So, hello, Dr. Bluming. It's Bluming right?

Dr. Avrum Bluming: That's correct.

Avrum, I will call you. So we spoke about the WHI and HRT. We've spoken about osteoporosis. Now I need to ask you about HRT and the heart, because there is a lot of contradictory information out there. Is HRT good for the heart? Does it do nothing for the heart? Here's my anecdotal evidence. This is what happened to me recently. So 2016, I had recently had my uterus out. I go to a cardiologist with heartbeats that felt irregular. She puts me on a Holter monitor for a month. I'm diagnosed with PVCs. What is that called? Post ventricular-

Premature ventricular contractions.

Yes, that. And she puts me on metoprolol and beta blockers, all sorts of drugs that I take and I hate them, and I stopped taking them because the side effects are brain fog and exhaustion and things that I don't want to deal with when I'm a single parent working and trying to raise a family. So fast-forward to several years later, I'm on HRT and I noticed, "Oh, I don't have these PVCs anymore." What I was told back then was that these PVCs were psychologically induced because I had just gotten divorced. I had just gotten my uterus out. I had to move. I was single parenting three children, one of whom was seven years old. All these things that were life stressors, which by the way I can handle, it wasn't like I was that stressed out, but I suddenly saw myself as someone who was incredibly stressed out. There was a self-perception issue too, like, "Oh, I better not be this stressed out."

Again, fast-forward to whenever I started taking HRT [2022] and I noticed the PVCs are gone, and I thought, "Well, I've moved on in my life. I have a partner that I love. My life is much calmer than it was back then. It must be the lack of stress." Well then, last week, I was on vacation with my mom. I went to my mom's house in Delaware. I forgot to bring my Oestrogel and for a whole week I was not on HRT, actually 10 days, I was not on HRT. By the end of that week, the PVCs were so strong and my hot flashes were hitting me one after the other, after the other that I thought, "Oh my God, I bet that this Oestrogel has been keeping me from having those PVCs." What do you say about all of this?